Wallace Edmondson Taylor Jr., M.D.

Primary specialty

Otolaryngology PhysicianTaxonomy code 207Y00000X

License

28006 Issued in CO

Practice address

300 Beardsley LN
Suite D-101
Austin, TX 78746-4945

Phone

(512) 338-9840

Fax

(512) 338-0863

NPI assigned

Dec 2, 2005

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Mar 20, 2019 through Mar 20, 2027

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• United Otolaryngology Associates, PLLC

  • Otology & Neurotology Physician
  • Austin, TX
  • NPI 1053504878
  NPD (past)
• Lutheran Hospital Association of the San Luis Valley

  • General Acute Care Hospital
  • Alamosa, CO
  • NPI 1235181744
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1133481600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1228348800000",
    "number": "1831173707",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 BEARDSLEY LN",
            "address_2": "SUITE D-101",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787464945",
            "telephone_number": "512-338-9840",
            "fax_number": "512-338-0863"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 BEARDSLEY LN",
            "address_2": "SUITE D-101",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787464945",
            "telephone_number": "512-338-9840",
            "fax_number": "512-338-0863"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TAYLOR",
        "first_name": "WALLACE",
        "middle_name": "EDMONDSON",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-02",
        "last_updated": "2008-12-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "CO",
            "license": "28006",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01280064",
            "state": "CO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD CARRIER",
            "identifier": "P00209209",
            "state": "CO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BC/BS",
            "identifier": "TA37805",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Tara Taylor, BCBA
• Teresa Taylor
• Terry W Taylor, CRNA
• Tess Lenae Taylor, LPC, LCDC
• Tina Taylor
• William Peyton Taylor, M.D.
• Yvonne Taylor
• Taylored to You Clinic & Consultation PLLC
• Taylors Loving Care
• Tays General Dentistry PA

• Otolaryngology Physician in Austin, TX
• Providers in Austin, TX by specialty
• Otolaryngology Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 4, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.